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Biomedical subjects

J Loiret

Publications and source records attributed to J Loiret.

14 recordsLinked to original sources
PubMed1997

[Isolated left ventricular muscular diverticulum in an adult. Value of non-invasive examinations].

The authors report a case of ventriculum in a 45 year old women investigated for chest pain. This was a congenital muscular left ventricular diverticulum confirmed by a complete imaging series including echocardiography, magnetic resonance imaging, angio-scintigraphy and conventional angiography. This diverticulum was unusual due to the fact that there was no associated congenital disease and that it was discovered in an adult. The authors review the literature and discuss the value of non-invasive imaging procedures.

Angiocardiography↗
PubMed1997

[Management of myocardial infarction in patients over 75 years of age compared to patients under 75 years of age. Apropos of 594 consecutive cases admitted between 1991 and 1994].

This study analyses the patients consecutively admitted for myocardial infarction between January 1991 and December 1994. The study population consisted of 594 patients divided into two groups: 446 patients under the age of 75 years and 178 patients over the age of 75 years. The sex-ratio showed a male predominance (84%) before 75 years, and a female predominance (57%) after 75 years. A history of angina was more frequent in elderly patients (45% vs 30%, p < 0.001), who were admitted later (22.5% vs 46.6% before the 6th hour, p < 0.001). Thrombolysis was administered in 49.6% of subjects under the age of 75 years and in 17.3% of elderly patients. The course was uneventful in 56.7% of subjects under the age of 75 years and in 28.2% of elderly patients. Mortality was 6-fold higher in this group (22% vs 3.7%, p < 0.01). The cause of death was usually heart failure with a 10-fold higher frequency of cardiogenic shock (13.5% vs 1.4%, p < 0.001). Coronary angiography was performed in 81.4% of subjects under the age of 75 years and in 30% of the elderly patients. Multi-vessel lesions were more frequent in elderly subjects (78.4% vs 47.5%, p < 0.01). Revascularization by angioplasty or bypass graft was performed with a similar frequency (50%) in the two groups of patients investigated by coronary angiography. The mortality of myocardial infarction was high in the elderly, usually due to heart failure, and partly explained by the severity of the coronary lesions; in contrast, elderly patients were less frequently submitted to active management (thrombolysis-coronary angiography), while recent data of the literature argue in favour of primary angiography in these patients.

Aged↗
PubMed1992

[Recurrent syncope during deglutition. An uncommon form of sinusal dysfunction].

The authors report the case of a 69 year old man with a 16 year history of syncope occurring only while swallowing liquids. Two episodes were observed during a hospital admission to the intensive care unit for unstable angina and allowed documentation of prolonged sinus arrest (7 sec) causing syncope. In the light of this case and a review of the literature, the physiopathological role of deglutition in the genesis of cardiac conduction defects and arrhythmias is discussed and the new classification of sinus node dysfunction proposed by Bashour in 1985 is recalled.

Aged↗
PubMed1989

[Q fever infectious endocarditis. Apropos of a new case].

We report a case of Coxiella burnetii endocarditis in a 42-year old man presenting with a long-known cardiac murmur and an infectious syndrome of several months duration. The aetiological diagnosis, delayed by the lack of knowledge of a primary Q fever, was established by serology. The infection responded to tetracycline combined with cotrimoxazole, but a valve replacement performed for haemodynamic reasons was followed by serious complications. We remind the readers that Q fever endocarditis must be considered as a possible diagnosis in all cases of endocarditis with negative blood cultures and that specific serological examinations in search of anti-phase I antibodies of the IgA type should be performed as soon as possible, using the indirect immunofluorescence technique. Attention is drawn to the different serological responses of the three clinical types of Q fever infection and to the cellular immunity associated with that disease.

Adult↗
PubMed1988

[Multiple proximal coronaro-pulmonary fistulae. Review of the literature apropos of a new case].

The authors report a new case of multiple proximal coronaro-pulmonary fistula between right coronary arteries, anterior interventricular artery and the trunk of the pulmonary artery, in a 64 year-old female patient with chest pain and a continuous murmur located in the third left intercostal space. The coronary steal is demonstrated by a myocardial scintigraphy during stress with return to normal after surgical ligation. A review of the literature enabled to find 33 cases of this major congenital anomaly of the coronary arteries, defined as an abnormal communication between at least two main coronary vessels and the trunk of the pulmonary artery. This results in a left-right shunt, usually minor without any repercussions on the right cavities and pulmonary pressures. The entire clinical, electrocardiographic, radiological, sonographic, scintigraphic, haemodynamic and angiographic picture is reported for these 33 cases. A physiopathological discussion is proposed. The course of this disease is usually favorable (only one case of myocardial infarction was published, without cardiac failure. Osler's endocarditis or sudden death); this seems to authorize simple monitoring as a logical therapeutic approach except when a myocardial ischemia secondary to coronary steal is demonstrated, imposing a surgical correction.

Arterio-Arterial Fistula↗
PubMed1988

[Right coronary artery issuing from the pulmonary artery: review of the literature apropos of a case].

A new case of right coronary artery abnormally issued from the pulmonary trunk is reported. The patient was an asymptomatic young man in whom a continuous cardiac murmur was discovered by chance and an angiographic examination disclosed the coronary abnormality. A review of the literature yielded 37 cases of this anomalous origin which was either isolated, as in the case reported here, or associated with another congenital or acquired cardiopathy. The diagnosis may be suspected on the presence of a continuous murmur in an usually asymptomatic subject and is confirmed by angiography. The abnormality is generally well tolerated owing to an inter-coronary collateral circulation resulting in retrograde perfusion of the right coronary artery from the left coronary artery. This good tolerance explains why an isolated abnormality of that type is often discovered belatedly, in contrast with the anomalous origin of the left coronary artery from the pulmonary trunk, which is usually revealed at birth by clinical signs of acute coronary insufficiency. However, the likelihood of either cardiac failure due to the left-to-right shunt in elderly people or, chiefly, acute myocardial ischaemia by coronary steal with a risk of sudden death in young people makes it imperative in such cases to perform reimplantation surgery.

Adult↗
PubMed1987

[Cardiobacterium hominis on a aortic valve prosthesis].

A new case of late bacterial endocarditis caused by Cardiobacterium hominis is reported. The infection developed on an aortic valve prosthesis and responded favourably to medical treatment. The main characteristics of the micro-organism and of the oslerian graft are reviewed in the light of published data. The problem of endocarditis with negative blood cultures is discussed since C. hominis is reputed difficult to cultivate, although this was not the case in our patient.

Aortic Valve↗
PubMed1986

[A case of severe catecholaminergic bitachycardia].

The authors report the electrophysiological study of severe catecholaminergic double tachycardia in a young athletic subject with an apparently healthy heart. The literature is reviewed and the mechanisms of double tachycardia are discussed, together with the role of the sympathetic nervous system and the therapeutic implications.

Adrenergic beta-Antagonists↗